Life imitates The Price We Pay
If there’s one thing you learn from Marty Makary’s blockbuster expose The Price We Pay (other than Quizzify being a great vendor, on page 226), it’s not to get a peripheral vascular screen at a community center.
Here are his exact words from his trip to a community center hosting a screening session for peripheral vascular disease:
The person from the cardiology group was conducting a test that measures how the blood flow in the legs compares to the blood flow in the arms. The rationale: Something might be wrong if the blood pressure is lower in the legs. It could be caused by a narrowing of the arteries, a plaque that slows blood flow. It might warrant further investigation.
There’s just one problem with that notion: This test should not be performed unless a patient has serious symptoms, like crippling leg pain. For anyone else, it’s likely to lead to medical care they don’t need, which can be expensive and dangerous. That’s exactly why independent medical experts do not recommend the type of peripheral vascular screening I witnessed that day.
So, thanks to the chronic shortage of other subject matter for these periodic blogs now that wellness vendors have finally learned not to brag publicly about their stupidity, imagine my glee when a brochure from Life Line Screening arrived in the mail last week urging me to: get peripheral vascular screening at a community center.
Not only that, but my special “priority code” meant I “qualified” for a large, exclusive, discount (“Only $149”). I was very pleased to hear that — just like achieving Mosaic on JetBlue, Titanium Ambassador in Marriott, and something like Executive Platinum Emerald Diamond Palladium Plutonium Selenium Sodium Fluoride on American — I had also achieved “Status” with Life Line.
Needless to say I wanted to brag about this achievement to all my friends-and-relations who also got this mailing. But my ego took a hit when I learned that apparently they too received high-priority codes and qualified for this exact same exclusive discount. Trying to figure out what we all had in common to earn this special treatment, we concluded that this it was being offered — exclusively — to people who are comprised of protoplasm.
In addition to the peripheral vascular disease screening, rated “D” by the US Preventive Services Task Force in my 40-64-year-old group, they are offering the following additional “vital screenings,” with the USPSTF rating in parentheses:
- Abdominal aortic aneurysm screening (D for nonsmokers under 65)
- Heart rhythm screening (I rating)
- Osteoporosis (I rating)
- Carotid artery screening (D rating)
For those uninitiated in USPSTF screening ratings, “D” means “don’t screen for this,” because of the overwhelming likelihood that positives will be false.
How overwhelming is this likelihood? Let’s take an example. Suppose you perform a test that’s 90% accurate to hunt for a previously undetected, symptomless, disease in 1000 people. Suppose further that about 1 in 1000 adults 40 to 64 has this undetected disease. A 90% accurate test is also 10% inaccurate. So, including the one person who actually has the disease, about 100 of the other 999 will test positive — despite being disease-free.
Those 100 are going to be totally stressed out for no reason, probably follow up with more tests, and possibly even get surgery. Here is the math:
Continuing with my USPSTF grading lesson for Life Line, “I” means “Incomplete,” not enough data for a recommendation. I don’t have to tell you what “A” and “B” mean because those ratings don’t apply to any of Life Line’s screens. That’s right. None of Life Line’s tests are recommended by the specific entity charged with recommending tests.
Needless to say, I couldn’t pass up the opportunity to call these Very Stable Geniuses. My call was answered by a Life Line employee who announced: “My name is XXXX. I’m going to be your Preventative Healthcare Advisor.” When I asked if these tests had an A Rating from from the US Preventive Services Task Force, she replied: “Very very very true. Also an A-Plus rating from the Better Business Bureau.”
She also assured me I could keep my clothes on, which I know the staff and guests of the Wellesley Community Center will appreciate.
The benefits of screening
Hmmm. Let’s look at each of these five claims in turn.
- “Early detection.” Check. Detection of more false positives than every wellness vendor except possibly Interactive Health, which specializes in them. (See “Interactive Health gives clueless wellness vendors a bad name.“)
- “Prevention of disease progression.” Screening might possibly detect something but it doesn’t prevent anything. Here’s what might prevent something: spending that $149 on a new pair of sneakers and running in the opposite direction of the Wellesley Community Center.
- “Peace of mind.” Try telling that to all the people who are getting false positives.
- “Savings with more affordable screenings.” I called my Preventative Healthcare Advisor to ask about that one. Turns out, as noted below, I can practically retire off these savings.
- “Control, no insurance required” ? “Required” is synonymous with “coverage” in this case. Just like “true” was synonymous with “false” about the USPSTF A ratings.
So…doctors don’t do these screens, insurance doesn’t cover them, and yet somehow, somehow, these screens are… “vital“? Time for another call to my preventative healthcare adviser to find out why, if these tests are so vital, doctors don’t do them. She explained that:
- Doctors will only do these tests for: “a reason” (shame on doctors!)
- But by then it might be “too late.”
- Doctors don’t do these tests routinely because they cost “$5000 to $8000,” instead of $149. That’s why the brochure lists “savings” as a benefit. You could save thousands right now by doing these screenings! Likewise, think of all the money you’re saving this month alone by not living in a $5000/month apartment.
- “Insurance companies are all about the money. They try to control our lives. That’s why they won’t pay for these tests.” (There is actually an element of truth to this one. Insurance companies are all about the money. Not unlike Life Line, which is clearly in business for their health, since they aren’t in it for ours.)
Postscript: I did check in with a primary care physician, who observed that she’s heard of doctors doing tests without “a reason.” But advertising that they do tests for no reason? That was news to her. She said they could lose their license. I pointed out that wellness vendors don’t need licenses, or for that matter even GEDs. Just the willingness to check their ethics at the door of the Wellesley Community Center. Plus a soupcon of protoplasm.